Provider Demographics
NPI:1962697029
Name:JOSEPH E MOUHANNA MD PA
Entity type:Organization
Organization Name:JOSEPH E MOUHANNA MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOUHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-445-7246
Mailing Address - Street 1:7575 SW 62ND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4904
Mailing Address - Country:US
Mailing Address - Phone:305-445-7246
Mailing Address - Fax:305-447-6588
Practice Address - Street 1:7575 SW 62ND AVE STE B
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4904
Practice Address - Country:US
Practice Address - Phone:305-445-7246
Practice Address - Fax:305-447-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8554Medicare PIN